Transtibial Stumps without Fibula – Prosthetic Implications

If a transtibial amputee has had their fibula removed as part of their amputation, what are the implications prosthetically and are there any potential problems that are more likely to develop as a result of the altered anatomy of the residuum?

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4 comments

Tony

I have not treated a transtibial amputee without a fibula, but there may be a couple of advantages: no head of fibula requiring bony relief in the socket (or distal fibula); perhaps less risk of peroneal nerve irritation; and maybe now there could be a ‘lateral flare’ of the tibia to join with the medial flare to assist as a weight bearing surface.

Of course it may depend on the actual surgical result – is there still the tibial side of the superior tibio-femoral joint that has to have relief? How much of the tibialis anterior muscle group is left? If there is less residual soft tissue there is obviously a higher risk of skin damage over the bony surfaces, especially if there is scarring and adhesions, and more difficulty in finding a lateral surface tolerant of increased pressure during stance phase lateral shift.

There is also literature talking about removal of fibulas in shorter stumps to reduce pressure intolerant bony prominences, so it may be more common than we think. There are also a couple of high profile amputee athletes apparently born without fibulas, including Oscar Pistorius and Aimee Mullins, so there must be good methods of designing sockets for people of these activity levels! Perhaps TSB sockets are better at accommodating these stumps as the normal principles of moulding PTB sockets may be more difficult to apply.

Let us know how it turns out!
Tony

Alison

We had amputee clinic today and I ran this question by our prosthetist as I have never treated someone like this. He has made legs for a number of people without fibulas and he said from a prosthetic perspective it doesn’t really make any difference. If anything it makes it easier due to less bony prominences.

Let us know how it goes!
Ali

Sheila

Speak with a prosthetist and they will tell you very much the same as Tony. No head of fibula or distal fibula requiring relief and the benefits of having a lateral tibial flare as an additional weightbearing surface

lynette wakefield

I’ve seen this techniques cited as a way of ensuring that all devascualrised soft tissue is removed and avoiding delaying of wound closure, infection and large and adherent scars. Surprisingly it was reported to have no negative effects on rehabilation including prosthetic use providng enough of the gastroc complex was vaiable to pad the remaning bony stump particularly distally and achieve wound closure. My prosthetic contacts had no issues with the concept either, although it is not a practivce I’ve seen in used. Perhaps this is becuase there are now more accurate ways of determining the vascularity of tissues through diagnostic measures or attempts at reconstructive surgery prior to amputation.